Current Treatments

In most cases, treatment goals are aimed at pain relief, and are based on medications. Once a surgical procedure is warrented, the standard of care depends on the location of the lesion, its size and depth.

Debriedment

For smaller lesions, palliative procedures such as arthroscopic debridement that involves removing the damaged cartilage are often utilized. This treatment option is considered symptomatic and short term.

Micro-Fracture (MF)

For mid-sized lesions, marrow stimulating techniques are common. These procedures aim to generate new cartilage by inducing bleeding from the bone, which starts a healing process. However, the cartilage generated through marrow stimulation is not of the right type: it has inferior biomechanical properties which almost inevitably lead to recurring deterioration of the joint and the return of symptoms.

Autologous Cartilage Implantation (ACI)

The modern approach seeks biological solutions by replacing damaged tissue with living cells. In ACI, cells are cultured from tissue taken from the patient himself during arthroscopy, cultured and re-implanted through a second surgery.  Although ACI has been introduced over a decade ago, only a small percent of eligible candidates have undergone the procedure. The main reason for this is the well-known phenomenon of caritlage cell de-differentiation, which causes harvested hyaline caltialge cells to revert to fibro-cartilage upon culturing. The resulting tissue is therefore not the required one, leading to unsatifactory long-term results. In addition, ACI limitations include the need to perform two procedures, (harvesting and implantation), its high associated costs, and the fact that it most patients are not sutiable donors, and as a result – cannot use it.

Total Knee Replacement (TKR)

In cases of extreme and persistent cartilage damage in which other treatment options have failed, a total knee replacement may be performed. This is a surgical procedure in which the surface of the worn-out knee joint is replaced with metal and plastic components shaped to allow continued motion. Post operatively, physicial therpay is required to assist in recovery, and limited joint movement may be experienced as a result of the surgery. Even though TKR is the option of last resort and doesn’t last for more than 10 years, more than 580,000 TKR procedures take place each year in the US alone (CDC National Hospital Discharge Survey).

What is needed?

Rahter than generating scar tissue or replacing the knee with artificial materials, the ultimate goal of cartilage injury treatment is to restore the surface of the joint to a normal articular cartilage surface. Unfortunately, to date  despite many attempts to develop clinically useful procedures for articular cartilage repair, no technique delivers this outcome. Treatment options are still very limited and present a clear unmet medical need.